Chronic Obstructive disease : Chronic Obstructive disease Thelma Monterroso, RN, BSN
Image retrieved from http://www.getbodysmart.com/ap/resp/resp.htm Objectives : Objectives Discussed the anatomy of respiratory system
Define and discuss types of chronic obstructive disease
Identify the etiologies of chronic obstructive pulmonary disease.
Describe its pathophysiology
Identify and discuss assessment criteria used in the care of the patient with chronic obstructive pulmonary disease.
Understand the care and management of patient with chronic obstructive disease.
Discuss health promotion and prevention Anatomy of the lung : Anatomy of the lung Respiratory function
Image retrieved from http://www.thoracic.org/sections/copd/for-patients/anatomy-and-function-of-the-normal-lung.html Alveoli Image retrieved from http://www.thoracic.org/sections/copd/for-patients/anatomy-and-function-of-the-normal-lung.html Definition of COPD : Definition of COPD Chronic obstructive pulmonary disease (COPD) refers to a group of lung diseases that are characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases (Kluwer, 2008).
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http://www.steadyhealth.com/articles/user_files/4542/Image/emphysem.jpg Facts of COPD : Facts of COPD Major cause of death and disability U.S.A
4th leading cause of death in men U.S.A
5th leading cause of death in women U.S.A
Mortality rates in women have increased by 53% and are still rising (American Lung Association, 2009)
Picture retrieved from http://www.freakingnews.com/Cigarettes-Pictures---1507.asp Risk Factors : Risk Factors Smoking is the most common cause of COPD, accounting for 80-90 percent of all deaths.
Second-hand smoke. Other causes of COPD include a history of childhood respiratory infections and heredity.
Researchers are identifying certain genetic traits (American Lung Association, 2009)
Picture retrieved from http://www.freakingnews.com/Cigarettes-Pictures--1507.asp Types of COPD : Types of COPD Chronic bronchitis
Chronic infection or irritation of the bronchi. The mucus glands of the tracheobronchial tree become thicken and encroach on the diameter of the airway lumen. Increase mucus production in the peripheral airways. May be reversible in early states
Defined as the presence of cough and sputum production for at least 3 month (Hargrove-Huttel, 2004) Types of COPD cont. : Types of COPD cont. Emphysema
Irreversible dilatation of the alveolus accompanied by destructive changes in the alveolar walls.
- loss of recoil
- bullae development (Hargrove-Huttel, 2004)
Press the website below to see video
http://www.virtualmedicalcentre.com/humanatlas1/vmc_white.asp?anid=0094 COPD – Pathophysiology : COPD – Pathophysiology Not completely understood
Cigarette smoke main trigger
Chronic inflammation of cells lining bronchial tree
Leads to airway narrowing
Excess mucus production
Decreased ciliary function (Huether & McCance, 2007) COPD – Pathophysiology : COPD – Pathophysiology Hallmark of COPD
Increased mucus production and reduced mucociliary clearance - cough and sputum production
Loss of elastic recoil - airway collapse
Increase smooth muscle tone
Gas exchange abnormalities - hypoxemia and/or hypercapnia (The National Heart, Lung, and Blood Institute, 2009)
Image retrieved from http://www.nhlbi.nih.gov/health/public/lung/copd COPD – Pathophysiology cont. : COPD – Pathophysiology cont. Top picture reveals a healthy aveolie
The bottom picture shows damage to aveolie due to COPD (Mayo Foundation for Medical Education and Research, 2009)
Image retrieved from http://mayoclinic.com/health/copd/DS00916 Key Indicators for COPD Diagnosis : Key Indicators for COPD Diagnosis Physical signs : Physical signs Large barrel shaped chest (hyperinflation)
Prominent accessory respiratory muscles in neck and use of accessory muscle in respiration
Low, flat diaphragm
Diminished breath sound. (Mayo Clinic, 2009)
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http://mayoclinic.com/health/copd/DS00916 Diagnosis of COPD : Diagnosis of COPD Image retrieved from http://emedicine.medscape.com/article/412482-overview Sign and Symptoms of COPD : Sign and Symptoms of COPD Decrease exercise tolerance
SOB, tachypnea, thin
cough (smokers cough)
Decreased FEV1 (evidence of airway production) test used is spirometry
Copious amount of sputum
Increase Paco2 (ABG)
Marked hypoxemia = polycythemia and cynosis (McCance & Huether, 2006)
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Press below web site to see sound video
http://www.med.ucla.edu/wilkes/wheezemain.htm Diagnosis of COPD : Diagnosis of COPD Dx
Best tool is pulmonary function testing (decrease spirometry)
History of symptoms
ABG Hypoxia is main sign, increases with severity of disease.
R sided heart failure (Cor Pulmonal)
BNP (helps more to dif from CHF)
ECG or recent Echo with EF (McCance & Huether, 2006)
Picture retrieved from http://mayoclinic.com/health/copd/DS00916 Classification of Chronic Obstructive Pulmonary Disease by Severity : Classification of Chronic Obstructive Pulmonary Disease by Severity MANAGEMENTCOPD : MANAGEMENTCOPD Management:
1) Smoking cessation
2) Chronic stable patients
EVEN IN SEVERE CASES OF COPD THERAPY IS POSSIBLE AND CAN IMPROVE QOL (American Lung Association, 2009) Chronic Stable COPDTreatment : Chronic Stable COPDTreatment Patient & Family education
(McCance & Huether, 2006) SMOKING CESSATION : SMOKING CESSATION The only intervention shown to slow the progression of COPD
Small improvements in FEV1
Eventually the rate of decline in lung function returns to the same level of a non-smoker
Brief interventions are effective (American Lung Association, 2009) Pharmacotherapy for Stable COPD : Pharmacotherapy for Stable COPD Bronchodilators
Short-acting b2-agonist – Salbutamol
Long-acting b2-agonist - Salmeterol and Formoterol
Anticholinergics – Ipratropium, Tiiotropium
Methylxanthines – Theophylline
(McCance & Huether, 2006) Steroids
Oral – Prednisolone
Inhaled - Fluticasone, Budesonide Pulmonary Rehabilitation : Pulmonary Rehabilitation Pts with COPD are often deconditioned
Leads to muscle wasting – contributes to dyspnea
Should encourage all pts to remain active
Formal rehab programs improve QOL and dyspnea (The National Heart, Lung, and Blood Institute, 2009)
play video below:
http://www.youtube.com/watch?v=mjb43FkRGtQ Don’t forget : Don’t forget Flu shot
Vaccinations help prevent exacerbations! End of life issues : End of life issues QOL of patients with COPD is often poor (especially end stage disease)
Mortality during acute exacerbations 10-20%
Discussions of end-of-life issues often occur late (and in the ICU)
Recommend targeting patients with advanced disease & have survived ICU (The National Heart, Lung, and Blood Institute, 2009) COPDSUMMARY : COPDSUMMARY COPD is preventable and treatable
Most not diagnosed until late – prevention is paramount
Spirometry is indicated for target groups
Smoking cessation is the only intervention shown to slow disease progression ConclusionWhat ever happen to the Marlboro man? : ConclusionWhat ever happen to the Marlboro man? http://www.youtube.com/watch?v=S9_VJFnm6Rs&eurl=http%3A%2F%2Fwww%2Ebing%2Ecom%2Fvideos%2Fsearch%3Fq%3Dmarbol%2Bman%2B%26qs%3Dn%26docid%3D1040985621262%26mid%3D3197B7C50CC2A3C1AADF3197B7C50CC2A3C1AADF%26FORM%3DVIVR&feature=player_embedded Press website below to see video: Summary Question : Summary Question 1) What is most common causes of Chronic obstructive pulmonary disease? Answer : Answer Smoking Question : Question 2) COPD is the number 1 cause of death in America?
False Answer : Answer 2) False it is the fourth leading cause of death in U.S. A. Question : Question 3) How would you expect Pao2 and Paco2 levels to show up in ABG analysis? Answer : Answer 3) Airway obstruction results in decrease ventilation thus ABG will reveal low PaO2 and high PaCo2. Question : Question 4) If a patient is hypoxia why is it a bad idea to give high amounts of oxygen? Answer : Answer 4) Because of chronic elevation of Paco2, the central chemoreceptors no longer act as the primary stimulus for breathing. The role is taken over by the peripheral chemoreceptors which are sensetive to changes in Pao2. Question : Question 5) What are the two main types of COPD? Answer : Answer 5) Bronchitis and emphasema Question : Question 5) What are the 5 key indicators of COPD? Answer : Answer 6) Chronic coughChronic
History of exposure to risk factors Question : Question 7) Chronic Obstructive Pulmonary Disease is classification of by severity which are? Answer : Answer 7) 0= at risk for COPD
I = Mild COPD
II = Moderate COPD
III = Severe COPD Question : Question 8) Which is the only intervention shown to slow the progression of COPD and improve FEV1? Answer : Answer 8) Smoking Cessation Question : Question 9) What is the first line of therapy in treating COPD and how do it work? Answer : Answer 9)All guidelines recommend inhaled bronchodilator as first line therapy because they work by reversing the increased bronchomotor tone, relaxing the smooth muscle, reduce the hyperinflation and improve breathlessness. Question : Question 10) What vaccination are recommended in order to prevent exacerbation? Answer : Answer 10) Flu shot
Pneumovax Reference : Reference American Lung Association. (2009). COPD fact sheet. Retrieved July 4, 2009,
American Thoracic Society (2009). Anatomy and Function of the Normal Lung. Retrieved July 5, 2009, from http://www.thoracic.org/sections/copd/for-patients/anatomy-and-function-of-the-normal-lung.html
Freeky new. (2009). Cigarettes Pictures: Marlboro Statue of liberty . Retrieved July 5, 2009, from http://www.freakingnews.com/Cigarettes-Pictures--1507.asp
Get body smart: Respiratory system. (2009). Retrieved July 5, 2009, from http://www.getbodysmart.com/ap/resp/resp.htm
Hargrove-Huttel, R.A. (2004). Lippincott's review series: Medical-surgical nursing (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Kluwer, W. (2008). Nursing: Understanding disease. Ambler, PA: Lippincott Williams & Wilkins. Reference : Reference Leader, D. (2009). Which Symptoms Led to Your COPD Diagnosis? Retrieved June 31, 2009, From http://z.about.com/d/copd/1/0/D/-/-/-/iStock_000001701812XSmall.jpg
Mayo Foundation for Medical Education and Research. (2009). COPD.
Retrieved July 6,2009, from http://mayoclinic.com/health/copd/DS00916
McCance, K. L., & Huether, S. E. (2006). Pathophysiology: The biologic basis for
disease in adults and children (5th ed.). St. Louis, MO: Elsevier Health Science.
McCance, K. L., & Huether, S. E. (2007). Understanding Pathophysiology.
(4thed.). St. Louis, MO: Elsevier Health Science.
Steady Health. (2008). Lung Diseases: Emphysema & tobacco smoke. Retrieved
July 5, 2009, from http://www.steadyhealth.com/articles/user_files/4542/Image/emphysem.jpg
The auscultation assistant. (2006). Breath sounds: Wheezes. Retrieved July 6, 2009, from http://www.med.ucla.edu/wilkes/wheezemain.htm Reference : Reference The Marlboro man. (2007). Video posted to http://www.youtube.com/watch?v=S9_VJFnm6Rs&eurl=http%3A%2F%2Fwww%2Ebing%2Ecom%2Fvideos%2Fsearch%3Fq%3Dmarbol%2Bman%2B%26qs%3Dn%26docid%3D1040985621262%26mid%3D3197B7C50CC2A3C1AADF3197B7C50CC2A3C1AADF%26FORM%3DVIVR&feature=player_embedded
The National Heart, Lung, and Blood Institute. (2009). It Has a Name: COPD Chronic Obstructive Pulmonary Disease. Retrieved July 5, 2009, from http://www.nhlbi.nih.gov/health/public/lung/copd
Treating COPD . (2009, July 3). Video posted to http://www.youtube.com/watch?v=mjb43FkRGtQ
Virtual Medical Centre. (2009). Emphysema. Retrieved July 3, 2009, from http://www.virtualmedicalcentre.com/humanatlas1/vmc_whitasp?anid=0094
Wood, B. (2008). Pulmonary interstitial emphysema. Retrieved from http://emedicine.medscape.com/article/412482-overview